Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Natalie IGEP > Approach to Geriatric pt > Flashcards

Approach to Geriatric pt Flashcards

1
Q

Five domains of geriatric assessment

A

Medical, Mental, Physical, Environmental, Care preferences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Medical assessment includes…(6)

A 
Present and past illnesses
Meds
Nutrition
Hearing and Vision
Pain
Urinary incontinence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Mental assessment includes…(3)

A

Cognitive status
Emotional status
Spiritual status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

During a mental assessment, what aspect is often overlooked?

A

Spiritual status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Physical assessment includes…(3)

A

Functional status
Balance and gait
Falls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Environmental assessment includes… (3)

A

social history (occupation, education, etc)
Financial status
Environmental hazards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Care preferences refers to…(3)

A

Goals of care
POLST/Advanced Directive
Power of Attorney.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does POLST stand for?

A

Physician’s Orders for Life Saving Treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Can you bill for time spent advising a patient on end of life decisions?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Dealing DIRECTLY with a patient enhances these 3 things

A

preserve personal dignity
promote connection and trust
instill meaning in your encounter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Should you call your patient by his or her first name?

A

No, use their surname

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When a patient is speaking slowly, should you complete their sentences for them to move things along?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what can family members help with for history?

A

Fill in gaps and corroborate details if needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Why do patients under-report pain?

A

Think it’s normal
Fear of illness or disability
Lack of concern d/t depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the most accurate way to get an idea of what medications the patient is taking?

A

Have them bring them in.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Things included in social history?

A 
Sex, drugs, alcohol
Hobbies, social life
Employment history
Economic status
Relationships with family/friends
Living arrangements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

GI ROS questions (4)

A

chewing difficulties, dysphagia, constipation, bowel incontinence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

GU ROS questions (3)

A

difficulty urinating, urinary incontinence, sexual dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

MSK ROS questions (1)

A

diffuse or focal pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Nuro ROS questions (4)

A

sensory changes, gait instability, recent falls, focal or diffuse weakness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

ROS special addition

A

Pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Psych ROS questions

A

Depression, anxiety or agitation, forgetfulness or confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are ADLs?

A

Activities of daily living: toileting, feeding, dressing, grooming, ambulation, bathing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are IADL’s?

A

Instrumental Activities of Daily Living: use the phone, shopping, food prep, housekeeping, laundry, transportation, medication management, finance handling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Can you get a full, holistic assessment done in one visit?

A

No, must take place over multiple visits and follow-up is essential

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Can you provide full, holistic care by yourself?

A

no, it’s a team effort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Who is involved in complete care of geriatric patient? (12)

A 
Medical provider
PT/OT
Speech Therapist
Social Workers
Pharm
Dentist
Audiologist
Specialist providers
Nurses
Nutritionist
Clergy if appropriate
Family members
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What can an audiologist provide?

A

Hearing evaluation, hear aid fitting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What can a dentist provide?

A

oral care. denture fitting. referral to specialists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What can a pharmacist help with?

A

ID meds with possible adverse reactions.
Recommend safe alternatives.
Prevent polypharmacy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What can a PT help with?

A

balance and gait, fall risk

provide therapy and modifications for treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What can an OT help with?

A

screening for ADL and IADLs. Home evaluation for safety. Provide modifications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What can Speech Therapist (ST) help with?

A

eval and treat swallowing difficulties

provide speech therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Can ST help people with neuro or cognitive deficits communicate better?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What will a social worker help with?

A

assess risk for abuse
investigate suspected abuse
help find community/home services

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What will a nutritionist/dietician help with?

A

food

37
Q

What is the goal BP for elderly?

A

SBP

38
Q

What is goal BP for someone with DM or CKD?

A

SBP

39
Q

What kind of BP should you check?

A

orthostatic

40
Q

What if you find an irregular pulse?

A

Remember that it’s not uncommon. If it’s new, get an EKG

41
Q

2 things to add to differential if there is a weight gain

A

Heart Failure

Ascites

42
Q

How much weight loss for it to be worrisome?

A

more than 5% over 1 year

43
Q

What could alert you to poor ADL fxn or abuse/neglect?

A

poor grooming

44
Q

If new onset of slowed speech, 2 things to think about

A

cognitive decline, parkinsons

45
Q

What does turgor indicate?

A

dehydration

46
Q

Big thing in skin exam to look for…

A

pressure ulcers. think reduced immobility or neglect

47
Q

If they can hear normal convo, what should you do?

A

whisper test

48
Q

If reduced vision, what is part of your plan?

A

refer to opthalmologist

49
Q

If stroke suspected, what vision should you test?

A

confrontation

50
Q

What common thing might you find in someone’s mouth?

A

thruth

51
Q

If you hear bibasilar crackles, what should you think?

A

pulmonary disease, or, if no other symptoms…

atelectasis

52
Q

What might make posterior lung exam hard?

A

kyphosis

53
Q

If you see an abdominal pulsation, what gets added to differential?

A

AAA. get ultrasound

54
Q

If the patient is thin and constipated, what might you palpate?

A

their stools

55
Q

What might you see on testicular exam?

A

atrophy

56
Q

What might you see on vaginal exam?

A

atrophy and dryness. very common

57
Q

Common occurrence with bladder or bowel?

A

prolapse

58
Q

What is periarticular swelling?

A

joint swelling

59
Q

Common labs that are affected by age…(8)

A 
sed rate
glucose
creatinine
albumin
alkaline phosphotase
Iron, TIBC, ferritin
PSA
UA
60
Q

common abnormal for Sed rate (up or down)?

A

mild elevation

61
Q

common abnormal for glucose?

A

tolerance decreases. elevated during acute illness

62
Q

Creatinine age changes

A

lean body mass decreases. higher end of normal or small elevation can mean SUBSTANTIAL decrease in renal function

63
Q

Albumin age changes

A

low levels usually indicate POOR NUTRITION in absence of liver disease, proteinuria, or absorption issues.

64
Q

Alkaline phosphatase age changes

A

mild asymptomatic elevations are common

65
Q

Iron, TIBV, Ferritin age changes

A

decreased values mean poor nutrition or GI blood loss

66
Q

PSA age changes

A

may be elevated with BPH. trending up or acute rise need further evaluation for prostate CA.

67
Q

What lab changes might indicate poor nutrition?

A

low iron, TIBC, ferritin.

low albumin/prealbumin

68
Q

UA age changes

A

asymptomatic UTI common.

69
Q

Should you treat an asymptomatic UTI?

A

no

70
Q

What 3 levels of measurement when evaluating ADL and IADL?

A
  1. ability to perform task independently
  2. ability to perform task with some assistance
  3. inability to perform task, even with assistance.
71
Q

Ways to measure/track cognitive capacity

A

Mini-cog
Mini Mental Status Eam
MOCA, SLUMS

72
Q

Most common test used for cog assessment

A

Mini Mental Status Exam

73
Q

Depression screening tools (2)

A

Quick: PHQ-2

Most common: PHQ-2

74
Q

What are the 2 main questions on the PHQ screens?

A

Little interest/pleasure in doing things

Feeling down/depressed/hopless

These are the 2 on PHQ-2. also on PHQ-9

75
Q

Ways to eval gait and balance (4)

A

Get Up and Go Test
POMA (performance oriented mobility assessment)
Stance: semi-tandem, full tandem (heal to toe)
Functional Reach Test

76
Q

What can a comprehensive geriatric assessment look at?

A

Everything pretty much, but also help determine is patient has capacity to make own decisions.

77
Q

When do you need a comprehensive geriatric assessment?

A

perceived need to transition to a higher level of care

78
Q

Are geriatricians easy to find?

A

nope

79
Q

What can a geriatrician help with?

A

Comp ger. assessement
Help with specific problems (cog changes, recurrent falls, incontinence)
Pre-op eval of high-risk pts

80
Q

Remember this about treatments for geriatric patients…

A

therapy (physical or pharm) can help one thing and make something else worse.

Balance every options pro and con!

81
Q

What is most important to geriatric patients?

A

You need to ask him or her.

living as long as possible
being pain free
maintaining function

depends on what the person wants

82
Q

2 spots to find evidence based practice advice

A

American Geriatric Society position papers

Choosing wisely

83
Q

What to take into account when discussing the plan

A

Cost
Risk and side effects
Clear descriptions of expected outcomes

84
Q

Always include this in decision making process

A

Prognosis

85
Q

Why prioritize decisions based on life expectancy?

A

to minimize tx unlike to provide benefit

limit harms without benefit

86
Q

what are the 4 principles of medical ethics?

A

autonomy
beneficence (well-being)
non-maleficence
justice

87
Q

How do you know what a person’s prognosis is?

A

use the tools available

88
Q

Clinical feasibility and individual preferences have what effect on the assessment and plan?

A

They SHOULD inform treatment choices

Natalie IGEP (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions